Outpatient Annual Report

Corry Counseling of LECOM Health

Mental Health Outpatient Program

FY 2020/21 Annual Program Report

Program Description

Corry Counseling of LECOM Health provides outpatient mental health services to Erie, Warren and Crawford County children and adults. The population includes individuals with severe mental illness and others with less severe emotional disorders.

Outpatient services include screening and assessment, safety planning, psychiatric evaluation, individual psychotherapy, group therapy, family therapy and medication management. For those accepted for outpatient services, an individual treatment plan is developed based on the needs as identified in the intake process. All treatment plans are developed under the supervision of the consulting psychiatrist and clients are seen for psychiatric evaluation and services as indicated. All clients accepted for service are registered with Erie County Care Management and/or Health Choices provider.

Children, who comprise approximately 35% of the agency’s total caseload, may be served in school at Corry Area Primary, Columbus Area Intermediate and Corry Middle-High School.

Consumer Satisfaction is monitored in partnership with the Mental Health Association of Erie County, in addition to agency client surveys.

Pre and post COVID-19 pandemic, telemedicine services are provided on average one week a month between the months of November and February. This added service allows for the psychiatrist to maintain continuity of care from alternative locations to a rural population during the winter months.

From July 1, 2020 through August 10, 2020, all service provision was done via telehealth/telephone. This was a direct result of the COVID 19 pandemic. During this time period, all individuals who receive medication injections were seen in-person by a psychiatric RN. All psychiatric evaluations were completed via ZOOM by the prescriber from their home office, with the individual on-site and accompanied by a psychiatric RN as a safety measure. From August 10, 2020 through November 13, 2020, service provision followed a hybrid model of in-person, telephone and telehealth appointments. COVID protocols were enforced for both staff and clients who were on-site. On November 16, 2020, COVID-19 restrictions were reinstated due to a rise in cases. Outpatient therapists and both prescribers returned to working remotely 100% of the time. The 3 psychiatric RNs and the Director of Outpatient continued to report on-site during this time. On April 5, 2021, all Outpatient staff returned to the office and resumed in-person appointments. Telehealth appointments were provided when there was an exceptional circumstance. However, in-person appointments remain the preferred method of service delivery.

The Outpatient Department was able to provide individuals with an initial psychiatric evaluation appointment within 7-10 days after completing their intake appointment.

Staff

For this fiscal year, Outpatient staff was comprised of 3 full-time therapists, 3 full-time psychiatric nurses, 1 Psychiatrist, 1 CRNP, and 1 Director of Outpatient Services. The retention rate for Outpatient staff was 100%.

Training

An annual training plan was developed for the Outpatient program. All licensed staff met the training requirements necessary to maintain current licensure. Additional training goals for this year were for staff to complete the following Agency required trainings: Annual Corporate Compliance Training, Abuse, Neglect and Exploitation of Older Adults, Emergency Response Plan Training and Rutgers University LGTBQIA+ Sensitivity training. Required Relias Trainings specific to the Outpatient Program were the following: Ethics for Professional Counselors (therapists only), Ethical Decision Making (nurses only), Best Practices in Trauma Specific Treatment and Best Practices for Delivering Telehealth. Outpatient staff met 100% of annual training goals for this fiscal year.

In December 2020, the Director of Outpatient and all Outpatient Therapists completed a 4-day training in Cognitive-Processing Therapy through a Pennsylvania State University grant-funded project. The therapists participated in weekly consultation calls from January 2021 through April 2021. There were barriers in being able to maintain fidelity to this model in a community-based outpatient setting, in addition to service provision largely being done remotely due to COVID-19. The 3 clients who were participating in CPT did not attend therapy consistently and eventually dropped out. Therefore, there were not any cases to present during the consultation call and therapists no longer participated in them.

The training goals for Outpatient staff for the upcoming fiscal year are for them to complete the following trainings: Annual Corporate Compliance Training, Emergency Response Plan, Fire Safety, Motivational Interviewing in Clinical Practice, Working More Effectively with the LGBTQIA+ Population, Best Practices in Suicide Screening and Assessment, Suicide-Specific Interventions and Best Practices, Advanced Practice in Treating Individuals with Co-occurring Disorders, Compassion Fatigue and Caregiver Satisfaction.

Licensed therapists and nursing staff are expected to meet the CE requirements to maintain their current licensure, including Suicide Prevention, Professional Ethics and Child Abuse Recognition and Reporting. An additional 6 hours of training for individual professional development will be chosen by individual staff members. All new employees will be expected to complete the training checklist for new staff in its entirety within 30 days of their start date.

Clients

The Outpatient Program served 1398 individuals this fiscal year. There were 581 intakes completed, of which 364 were adult assessments and 217 were child/adolescent assessments. There were 504 case closures. There were no specific concerns regarding referrals. Of those 1398 individuals, 1347 were White, 29 were Black, 11 were Hispanic, 2 were Native American, 3 were Asian, 3 were unknown and 3 were other. 753 were female clients and 645 were male clients. There were 6 clients ages 0-5, 247 clients ages 6-13, 189 clients ages 14-17, 189 clients ages 18-25, 422 clients ages 26-45, 258 clients 46-64 and 87 clients ages 65 and older. 4,738 hours of service were provided.

Productivity

Outpatient clinicians have consistently met and/or exceeded their productivity standard of 75% this fiscal year. The psychiatric nurses also have an expectation of 75% productivity. All of the nursing staff met or exceeded their expected number of medication appointments and Complex Case Coordination units.

Licensure Visits and Quality Audit

The annual licensure visit was completed on 05/18/2021. The only recommendation made was for the psychiatrist to be included in the quality assurance piece of the Outpatient program. Fraud, Waste and Abuse and Quality Audits were not conducted for Outpatient during this fiscal year.

Client Satisfaction Survey Results

On August 31, 2020, the Director of Outpatient facilitated an Outpatient Client Focus Group on the topic of client satisfaction of service delivery during the COVID-19 crisis. There were 7 clients who attended this group. The Telehealth Client Satisfaction Survey was utilized to initiate the discussion and elicit feedback. The feedback from clients regarding their individual experiences with telehealth was largely positive. All of the group participants concurred that telehealth is easier and more convenient for them, and eliminated barriers that are otherwise present for getting to in-person appointments. 2 of the participants reported that they would not have capability to do video appointments from their home. 1 client shared that, at times, it is challenging to find a private room in her home to talk to therapist.

The annual client satisfaction Surveys were not done in January 2021, due to Covid-19 restrictions.

Outcome Results

The target outcome for this fiscal year was that 85% of clients who are identified as depressed by the PHQ-9 or PHQ-A will have an improved score after 2 consecutive medication appointments, with 50% of those having a decrease of 25% or more. Due to clients receiving telehealth services for the majority of this fiscal year, data was not able to be obtained to measure this outcome.

In FY 2021/22, a second outcome is being added that focuses on client education about prescribed medication. The indicator is client agreement with a related statement on the client satisfaction survey (data source). The target is that 95% of clients for whom this is applicable report receiving and understanding medication education on the client survey.

The target goal for outpatient clients to attend their psychiatric evaluation was 95% this year. 90% of psychiatric evaluations were kept this year.

Expectations for the coming year

One goal is to achieve a 95% or greater attendance rate for psychiatric evaluations. Clients will continue to be contacted by telephone and/or letter to support their appointment attendance and resolve barriers to attendance. Telehealth services will continue to be utilized during the 2020-2021 fiscal year.

Clinical staff will enhance Outpatient Services by furthering their professional development, including obtaining more trainings on trauma-focused therapy modalities.

It is the expectation that Outpatient Staff will continue to be proficient in applying a trauma-informed approach in their daily practice.